Pediatric Tuberculosis in the United States, 1993–2017

Slide 1

Pediatric Tuberculosis in the United States, 1993–2017

Surveillance, Epidemiology, and Outbreak Investigations Branch 

Division of Tuberculosis Elimination

Centers for Disease Control and Prevention (CDC)

Slide 2

Background: Pediatric Tuberculosis

• Definition of pediatric tuberculosis (TB): 

o TB disease in a person <15 years old

• In 2017, 

o 9,105 TB cases were reported among all age groups 

o 429 (4.7%) were pediatric 

 53 (0.6%) in ages 0–1

 175 (1.9%) in ages 1-4

 93 (1.0%) in ages 5-9

 108 (1.2%) in ages 10-14

Slide 3

U.S. TB Cases, All Ages, by Age Group, 1993–2017

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

<15 years 1660 1659 1536 1356 1251 1077 1038 964 929 944 911 952 851 803 777 784 647 636 578 487 483 458 440 387 429

15-24 years 1821 1832 1697 1637 1674 1543 1518 1618 1597 1498 1573 1603 1540 1532 1580 1443 1279 1186 1029 1019 979 961 936 937 847

25-44 years 9589 9043 8200 7564 6884 6335 6062 5576 5610 5288 5074 4940 4737 4689 4311 4238 3885 3651 3364 3117 2964 2821 2858 2827 2758

45-64 years 6195 6126 5960 5572 5278 4954 4860 4635 4515 4182 4283 4192 4126 4039 4037 3928 3420 3415 3289 3113 2954 2956 3023 2844 2758

65+ years 5820 5540 5328 5076 4663 4377 4019 3515 3293 3142 2994 2811 2811 2663 2574 2496 2283 2212 2244 2198 2181 2202 2290 2254 2305
Slide 4

U.S. TB Case Rates*, All Ages, by Age Group, 1993–2017

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

<15 years 2.9 2.9 2.7 2.3 2.2 1.9 1.8 1.6 1.5 1.6 1.5 1.6 1.4 1.3 1.3 1.3 1.1 1.0 0.9 0.8 0.8 0.8 0.7 0.6 0.7

15-24 years 5.0 5.1 4.7 4.5 4.6 4.1 4.0 4.1 4.0 3.7 3.8 3.8 3.6 3.6 3.7 3.3 2.9 2.7 2.3 2.3 2.2 2.2 2.1 2.2 2.0

25-44 years 11.6 10.9 9.8 9.0 8.2 7.6 7.3 6.6 6.6 6.3 6.1 5.9 5.7 5.7 5.2 5.1 4.7 4.4 4.1 3.8 3.6 3.4 3.4 3.3 3.2

45-64 years 12.5 12.0 11.4 10.4 9.5 8.7 8.2 7.4 7.0 6.3 6.2 5.9 5.6 5.4 5.2 5.0 4.3 4.2 4.0 3.8 3.6 3.5 3.6 3.4 3.3

65+ years 17.7 16.7 15.8 14.9 13.6 12.7 11.6 10.0 9.3 8.8 8.3 7.8 7.7 7.2 6.8 6.4 5.8 5.5 5.4 5.1 4.9 4.8 4.8 4.6 4.5

*Rates are per 100,000 persons 

Note: Rates presented on a logarithmic scale

Slide 5

U.S. Pediatric TB Cases by Age Group, 1993–2017

N=22,037

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Age <1 year 156 139 118 102 111 103 96 91 97 101 95 81 80 91 115 116 93 76 72 59 66 46 54 48 53

Age 1–4 years 858 856 776 668 623 535 506 453 446 455 452 468 394 391 352 379 310 289 279 202 229 217 190 176 175

Age 5–9 years 358 395 393 368 305 243 250 222 208 196 195 203 195 159 159 141 140 139 96 109 92 99 88 71 93

Age 10–14 years 288 269 249 218 212 196 186 198 178 192 169 200 182 162 151 148 104 132 131 117 96 96 108 92 108

Slide 6

U.S. Pediatric TB Case Rates* by Age Group, 1993–2017

N=22,037

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Age <1 year 4.0 3.6 3.1 2.7 2.9 2.7 2.5 2.4 2.4 2.6 2.4 2.0 2.0 2.3 2.8 2.8 2.3 1.9 1.8 1.5 1.7 1.2 1.4 1.2 1.3

Age 1–4 years 5.4 5.4 4.9 4.3 4.1 3.5 3.3 3.0 2.9 2.9 2.9 3.0 2.5 2.5 2.2 2.3 1.9 1.8 1.7 1.3 1.4 1.4 1.2 1.1 1.1

Age 5–9 years 1.9 2.1 2.1 1.9 1.5 1.2 1.3 1.1 1.0 1.0 1.0 1.0 1.0 0.8 0.8 0.7 0.7 0.7 0.5 0.5 0.4 0.5 0.4 0.3 0.5

Age 10–14 years 1.6 1.4 1.3 1.1 1.1 1.0 1.0 1.0 0.8 0.9 0.8 0.9 0.9 0.8 0.7 0.7 0.5 0.6 0.6 0.6 0.5 0.5 0.5 0.4 0.5

*Rates are per 100,000 persons

Note: Rates presented on a logarithmic scale. 
Slide 7

Number of U.S. Pediatric TB Cases among U.S.-Born and Non-U.S.–Born Children, 1993–2017

N= 22,037

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Non-U.S.–Born 413 389 354 314 287 254 270 258 273 251 269 283 244 203 210 206 147 156 122 137 100 110 99 101 94

U.S.-Born 1231 1249 1180 1039 960 817 757 704 655 688 642 668 606 600 566 578 500 480 456 349 383 348 341 286 334

Slide 8

U.S.-Born Pediatric TB Cases by Race/Ethnicity, 1994–2017

N=15,186

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

White, non-Hispanic 207 164 141 103 104 100 84 67 82 63 54 52 49 55 38 39 36 41 31 39 32 26 20 13

Black, non-Hispanic 517 477 470 427 334 289 269 238 264 210 202 191 184 155 155 110 113 115 82 90 73 77 78 74

Hispanic 416 440 346 319 303 296 259 289 277 296 342 291 307 285 308 277 257 224 171 164 171 156 132 157

American Indian/

Alaska Native 30 34 36 29 15 15 27 8 13 13 13 12 9 8 10 4 13 12 14 11 4 16 10 11

Asian 66 42 30 50 44 45 45 42 42 59 53 52 49 59 65 65 57 59 42 74 58 62 45 71

Note: Multiple race/ethnicity and unknown not shown; Native Hawaiian and Other Pacific Islander combined with Asian.

Graph begins in 1994 to match availability of population data

Slide 9

U.S.-Born Pediatric TB Case Rates* by Race/Ethnicity, 1994–2017

N=15,186

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

White, non-Hispanic 0.53 0.42 0.37 0.27 0.28 0.27 0.23 0.18 0.22 0.18 0.15 0.15 0.14 0.16 0.11 0.12 0.11 0.12 0.10 0.12 0.10 0.08 0.07 0.04

Black, non-Hispanic 5.55 5.07 5.00 4.62 3.64 3.13 2.91 2.57 2.89 2.35 2.26 2.17 2.12 1.78 1.79 1.30 1.33 1.37 0.99 1.08 0.89 0.94 0.96 0.92

Hispanic 5.67 5.67 4.29 3.92 3.54 3.35 2.84 3.04 2.87 2.91 3.24 2.67 2.73 2.44 2.53 2.17 1.91 1.61 1.26 1.20 1.25 1.12 0.92 1.12

American Indian/

Alaska Native 7.32 12.06 5.86 4.71 2.75 2.47 4.14 1.16 1.87 3.30 3.08 2.74 2.42 2.11 2.76 1.13 2.88 2.75 2.77 1.92 0.69 3.46 2.13 1.95

Asian 5.94 4.85 1.58 2.55 2.08 2.08 2.14 1.93 1.92 2.96 2.78 2.62 2.31 2.68 2.93 2.89 2.33 2.33 1.66 2.84 2.15 2.33 1.68 2.48

*Rates are per 100,000 persons 

Note: Rates presented on a logarithmic scale

Graph begins in 1994 to match availability of population data

Multiple race and American Indian/Alaska Native not shown because of small denominators; Native Hawaiian and Other Pacific Islander combined with Asian
Slide 10

Non-U.S–Born TB Cases by Race-Ethnicity, 1994–2017

N=5,131

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

White, non-Hispanic 23 21 16 32 32 25 20 20 21 19 22 13 15 15 10 8 10 6 4 6 3 3 6 1

Black, non-Hispanic 40 40 44 41 38 53 65 72 64 47 87 72 67 69 73 48 64 42 44 33 32 33 34 34

Hispanic 223 182 166 119 116 132 114 124 123 135 115 104 80 68 48 33 26 31 17 19 17 20 29 27

Asian, non-Hispanic 98 107 82 90 63 56 57 56 43 64 59 53 40 57 74 56 55 42 71 40 55 40 31 32

Note: American Indian/Alaska Native, multiple race/ethnicity and unknown not shown because of small case counts; Native Hawaiian and Other Pacific Islander combined with 

Asian

Graph begins in 1994 to match availability of population data

Slide 11

Non-U.S.–Born Pediatric TB Case Rates* by Race-Ethnicity, 1994–2017

N=5,131

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

White, non-Hispanic 10.70 10.99 5.47 9.97 7.14 6.39 4.58 4.80 5.08 4.69 6.01 3.64 4.59 4.54 3.42 2.52 2.55 1.58 1.47 1.99 1.04 1.15 2.47 0.39

Black, non-Hispanic 37.14 50.54 50.23 42.66 26.47 45.79 48.13 57.54 42.78 30.92 52.31 44.22 38.79 42.00 34.69 25.98 48.93 27.07 32.58 20.84 13.03 12.30 13.04 13.11

Hispanic 23.26 21.05 18.83 12.50 12.99 13.72 11.55 13.03 10.91 12.73 11.25 10.09 7.02 6.29 4.70 3.60 2.92 4.47 2.24 2.97 2.62 3.51 6.03 3.84

Asian, non-Hispanic 30.39 40.28 16.25 19.91 14.02 13.78 12.05 12.96 9.88 14.70 13.62 12.54 9.30 14.14 15.72 12.46 11.19 9.22 14.97 9.09 12.83 7.90 2.09 5.88

*Rates are per 100,000 persons 

Note: Rates presented on a logarithmic scale

Graph begins in 1994 to match the availability of population data

American Indian/Alaska Native, multiple race/ethnicity and unknown not shown because of small denominators; Native Hawaiian and Other Pacific Islander combined with Asian
Slide 12

Pediatric TB Cases among U.S.-Born Children, by Age Group, 1994–2017 

N= 15,186

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Age < 1 year 132 110 92 103 88 87 81 85 97 90 77 76 82 108 104 90 71 71 55 65 43 48 44 51

Age 1–4 years 715 657 574 526 453 416 372 359 373 356 371 325 327 287 326 261 252 246 162 197 182 162 147 155

Age 5–9 years 251 277 263 217 172 153 151 122 125 109 124 117 115 96 85 87 89 68 73 66 70 66 51 67

Age 10–14 years 151 136 110 114 104 101 100 89 93 87 96 88 76 75 63 62 68 71 59 55 53 65 44 61

Graph begins in 1994 to match the availability of population data

Note: Cases in U.S.-born children of non-U.S.–born parents are included in the U.S.-born counts

Slide 13

Pediatric TB Cases Rates* among U.S.-Born Children, by Age Group, 1994–2017 

N= 15,186

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Age < 1 year 3.3 2.8 2.4 2.7 2.3 2.3 2.1 2.2 2.6 2.6 2.2 1.9 2.1 2.6 2.5 2.1 1.7 1.8 1.4 1.7 1.1 1.3 1.2 1.3

Age 1–4 years 4.4 4.1 3.6 3.4 2.9 2.7 2.4 2.3 2.4 2.2 2.3 2.0 2.0 1.8 2.0 1.6 1.5 1.4 1.0 1.2 1.1 1.0 0.9 1.0

Age 5–9 years 1.3 1.4 1.3 1.1 0.9 0.8 0.8 0.6 0.6 0.6 0.7 0.6 0.6 0.5 0.4 0.4 0.4 0.3 0.4 0.3 0.4 0.3 0.3 0.3

Age 10–14 years 0.8 0.7 0.6 0.6 0.6 0.5 0.5 0.5 0.5 0.4 0.5 0.4 0.4 0.4 0.3 0.3 0.4 0.4 0.3 0.3 0.3 0.3 0.2 0.3

*Rates are per 100,000 persons

Rates presented on a logarithmic scale

Graph begins in 1994 to match the availability of population data

Note: Cases in U.S.-born children of non-U.S.–born parents are included in the U.S.-born counts

Slide 14

Pediatric TB Cases among Non-U.S.–Born* Children, by Age Group, 1994–2017 

N= 5,131

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Age < 1 year 6 8 10 7 14 8 10 12 4 5 4 4 9 7 12 3 5 1 4 1 3 6 4 2

Age 1–4 years 127 118 92 96 79 86 80 86 79 96 97 69 64 65 53 49 37 33 39 32 35 28 29 20

Age 5–9 years 139 115 105 86 70 94 70 86 70 86 78 77 44 63 56 53 50 28 36 26 29 22 20 26

Age 10–14 years 117 113 107 98 91 82 98 89 98 82 104 94 86 75 85 42 64 60 58 41 43 43 48 46

*Non-U.S.–born refers to persons born outside the United States or its territories or not born to a U.S. citizen

Graph begins in 1994 to match the availability of population data
Slide 15

Pediatric TB Cases Rates* among Non-U.S.–born** Children, by Age Group, 1994–2017 

N= 5,131

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Age < 1 year 23.3 106.3 45.1 177.6 46.8 55.7 53.7 69.7 9.3 25.4 9.4 16.2 217.8 32.4 52.8 11.8 33.4 5.6 22.4 16.8 11.3 30.6 28.8 13.6

Age 1–4 years 61.6 56.6 37.8 38.6 32.7 35.1 28.9 25.4 24.7 34.5 32.5 24.1 21.9 25.3 19.6 17.7 12.7 17.2 18.0 18.7 16.7 11.5 10.7 5.6

Age 5–9 years 22.9 22.7 16.6 13.2 10.2 15.4 11.3 15.6 9.8 12.1 11.2 11.3 6.0 9.5 8.2 9.0 7.7 4.6 7.1 5.4 5.4 4.0 3.8 4.3

Age 10–14 years 14.9 16.1 12.3 10.6 9.3 8.1 8.7 8.6 9.3 7.7 10.8 9.2 8.1 7.1 8.3 4.2 6.5 6.6 6.2 4.6 5.1 5.3 5.9 5.6

*Rates are per 100,000 persons

**Non-U.S.–born refers to persons born outside the United States or its territories or not born to a U.S. citizen

Rates presented on a logarithmic scale

Graph begins in 1994 to match the availability of population data

Slide 16

Top Six Countries of Birth for U.S. Pediatric TB Cases, 1993–2017

Note: cases in U.S.-born children of non-U.S.–born parents are included in U.S.-born counts and thus not displayed in this figure

Slide 17

Number of U.S. Pediatric TB Cases among U.S.-Born Children by Parent/Guardian Status, 2010–2017

2010 2011 2012 2013 2014 2015 2016 2017

U.S. Born with U.S. Born Parents/Guardians 132 143 108 122 106 101 90 82

U.S. Born with Non U.S. born Parents/Guardians* 280 249 202 231 219 211 164 217

U.S. Born with Parents/Guardians with unknown origin 68 64 39 30 23 29 32 35

*At least one parent/guardian was non-U.S.–born

Country 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Mexico 185 185 153 130 90 94 104 80 92 99 112 77 72 63 48 34 25 19 22 10 10 8 9 10 11

Philippines 39 28 40 25 36 17 15 21 17 14 22 21 14 6 15 16 17 11 7 12 7 11 6 3 4

Somalia 10 9 6 17 11 9 18 17 24 20 8 20 21 16 14 11 7 7 6 8 3 3 1 6 3

Vietnam 33 25 28 15 20 11 12 8 8 8 13 5 5 13 5 6 5 5 6 5 2 2 3 1 0

Ethiopia 9 3 5 6 8 6 6 3 11 4 4 10 7 10 19 16 15 18 10 9 11 11 6 9 4

Haiti 18 10 13 11 7 8 8 5 11 14 12 22 5 6 7 13 4 18 7 4 3 4 3 1 2
Slide 18 

U.S. Pediatric TB Case Rates by State, 2013–2017

2013-2017

States (0 - <0.25) States 0.25 - < 0.50 States 0.50 - <1.00 States 1.00 +

Connecticut

Michigan 

Montana

New Mexico

Pennsylvania 

South Dakota

Vermont

West Virginia

Wisconsin

Wyoming 

Colorado

Indiana 

Iowa

Kansas

Kentucky

Mississippi

Missouri

Nebraska

New Hampshire 

Ohio

Oregon

Rhode Island 

Alabama

Arizona

California

Delaware

Florida

Idaho

Illinois

Louisiana

Maine

Maryland

Massachusetts

New Jersey

New York

North Carolina

North Dakota

Oklahoma

South Carolina

Tennessee

Utah

Virginia

Washington 

Alaska

Arkansas

District of Columbia

Georgia

Hawaii 

Minnesota

Nevada 

Texas
Slide 19

2009 TB Case Verification Criteria

• Incident case of disease 

• Case verification categories: 

1. Laboratory confirmed cases: 

• Positive result from culture or nucleic acid amplification test or 

• Acid-fast bacillus seen on sputum smear microscopy when culture not attainable 

2. Clinical case definition (all four criteria must be met) 

• Positive result from tuberculin skin test or interferon gamma release assay

• Signs and symptoms of TB disease 

• Current treatment for TB disease 

• Completed diagnostic evaluation

3. Provider diagnosis: 

• Diagnosed by health care provider 

• Does not meet all criteria for laboratory or clinical case definitions

Slide 20

U.S Pediatric TB Cases by Case Verification Criteria, 1993–2017

N=22,037

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Culture 374 378 341 314 298 241 245 247 264 234 215 234 218 220 214 215 166 164 157 141 166 116 138 122 149

NAA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 7 13 9 8 7 9 7 10 10

Smear 16 13 12 11 8 9 14 6 3 6 6 3 8 4 5 2 6 4 5 2 3 2 2 1 2

Clinical 

Case

920 890 804 746 660 609 532 470 447 477 433 452 400 328 333 336 362 355 345 285 251 269 243 210 222

Provider 

Diagnosis

350 378 379 285 285 218 247 241 215 227 257 263 225 251 225 230 106 100 62 51 56 62 50 44 46
Slide 21

U.S. Pediatric TB Cases by Case Verification Criteria and Age Group, Summed and Averaged Over 2013–2017

Age < 1 year, n=267

Laboratory Confirmed Clinical Case Provider Diagnosis

50% 29% 21%

Age 1–4 years, n=987

Laboratory Confirmed Clinical Case Provider Diagnosis

26% 62% 12%

Age 5–9 years, n=443

Laboratory Confirmed Clinical Case Provider Diagnosis

25% 64% 11%

Age 10–14 years, n=509

Laboratory Confirmed Clinical Case Provider Diagnosis

49% 45% 6%

Slide 22

U.S. Pediatric TB Cases by Site of Disease, 1993–2017

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Pulmonary Only 1230 1232 1143 986 900 757 733 690 636 661 622 657 555 505 541 548 440 440 397 333 340 313 285 256 274

Extrapulmonary Only 346 321 307 286 265 247 226 213 204 214 205 225 221 213 180 176 163 150 133 105 103 103 102 94 117

Both Pulmonary and 

Extrapulmonary 81 106 85 83 86 73 79 60 88 69 84 70 74 85 56 60 43 45 48 48 40 42 53 36 37

Note: Missing and unknown site of disease not included 
Slide 23 

U.S. Pediatric TB Cases by Site of Disease and Age Group, Summed and Average Over 2013–2017

Pulmonary 

Only

Extrapulmonary 

Only

Both Pulmonary 

and 

Extrapulmonary

Age <1 203 30 34

Age 1–4 705 194 87

Age 5–9 270 137 35

Age 10–14 290 158 52

Slide 24

Percentage of TB Cases in Children with Any Extrapulmonary Involvement* by Age Group (Age <5), Summed and Averaged 

Over 2013–2017

Lymphatic Meningeal Miliary Bone & Joint Other

Age <1 7.5 11.2 1.5 0.7 3.0

Age 1–4 17.3 6.4 0.5 1.6 2.6

*Includes cases that are extrapulmonary only and both, but not pulmonary only.

Cases are counted in mutually exclusive categories if multiple extrapulmonary sites are affected

Slide 25

Percentage of TB Cases in Children with Any Extrapulmonary Involvement* by Age Group (Age 5–14), Summed and Averaged 

Over 2013–2017

Lymphatic Meningeal Miliary Bone & Joint Other

Age 5–9 27.5 2.9 0.5 2.3 5.6

Age 10–14 21.4 2.6 0.6 2.8 14.6

*Includes cases that are extrapulmonary only and both, but not pulmonary only.

Cases are counted in mutually exclusive categories if multiple extrapulmonary sites are affected
Slide 26

U.S. Pediatric TB Cases by Reason Evaluated, 2010*–2017

2010 2011 2012 2013 2014 2015 2016 2017

Employee Testing 4 1 2 4 1 2 3 4

Incidental Laboratory 

Finding 25 17 16 16 17 22 20 26

Immigrant Exam 19 23 29 24 27 17 17 9

Abnormal Chest X-ray 135 123 95 76 74 60 61 55

TB Symptoms 180 179 155 160 144 142 128 138

Contact Investigation 229 216 166 191 166 180 142 175

*Reason evaluated was not collected by all reporting areas until 2010

Note: Excludes missing and unknown responses 

Slide 27

Percentage of U.S. Pediatric TB Cases by Reason Evaluated by Age Group (Age <5), Summed and Average Over 2010*–2017

Employ

ee 

Testing

Targeted 

Testing

Incidental 

Laboratory 

Finding

Immigrant 

Exam

Abnormal 

Chest X-Ray

TB 

Symptoms

Contact 

Investigation

Age < 1 0 0.8 3.2 1.1 16.2 31.4 46.4

Ages 1–4 0.3 3.2 2.9 2.9 19.6 26.0 44.5

*Reason evaluated was not collected by all reporting areas until 2010

Note: Excludes missing and unknown responses

Slide 28

Percentage of U.S. Pediatric TB Cases by Reason Evaluated by Age Group (Age 5–14), Summed and Average Over 2010*–2017

Employ

ee 

Testing

Targeted 

Testing

Incidental 

Laboratory 

Finding

Immigrant 

Exam

Abnormal 

Chest X-Ray

TB 

Symptoms

Contact 

Investigation

Ages 5–9 1.7 3.8 4.2 7.0 15.6 28.1 38.4

Ages 10–14 0.3 5.7 6.8 6.3 15.2 45.4 18.3

*Reason evaluated was not collected by all reporting areas until 2010

Note: Excludes missing and unknown responses
Slide 29

Number of Culture-Confirmed U.S. Pediatric TB Cases with Drug Resistance, 1993–2016

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

INH-Only 16 22 17 16 20 12 12 12 14 13 8 18 14 10 10 16 11 9 8 6 19 4 5 9

RIF-Only 1 4 2 1 2 0 0 2 1 0 1 0 2 1 0 3 1 2 0 1 0 0 1 0

MDR 6 6 4 6 4 6 5 1 3 4 3 1 5 4 4 5 3 2 3 3 2 1 0 0

MDR TB = resistance to at least isoniazid and rifampin

Slide 30

Number of U.S. Pediatric TB Cases by Type of Therapy, 1993–2015

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

DOT* only 366 445 628 639 691 627 585 594 574 608 576 626 548 523 494 534 428 415 386 331 324 318 311

Self-Administered only 1064 843 530 381 250 184 156 129 105 72 57 60 56 38 31 27 31 31 14 19 19 16 19

DOT* and Self-Administered 200 315 342 298 280 252 269 230 241 248 266 244 237 241 248 211 181 187 166 133 131 121 105

*DOT refers to Directly Observed Therapy 

Note: Alive at diagnosis and started on treatment

Slide 31

For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease 

Control and Prevention.